Comorbidity - Diabetes Mellitus Flashcards
What are the symptoms of type 1 diabetes?
Weight loss, fat breakdown, inability to metabolize nutrients, polyuria and polydipsia (kidneys attempt to rid bloodstream of excess glucose)
What is the medical treatment for type 1 diabetes?
Exogenous insulin
List the symptoms of type 2 diabetes.
Increased thirst, frequent urination, hunger, fatigue, blurred vision, in some cases no symptoms
What is the treatment for type 2 diabetes?
Diet, exercise
Oral medications or insulin
< 10% successfully managed with lifestyle changes alone
List the disease factors influencing illness management of type 2 diabetes.
Slow/insidious onset
Diagnosed during routine medical examination –> disturbing experience
Diabetes progresses (even with self-management) –> hopelessness
List the disease factors of both types of diabetes mellitus which influence illness management.
Various diabetic complications
Risk of hyperglycaemia and hypoglycaemia
BG maintained at levels near normal range = progression and diabetic complications significantly reduced
List some regimen factors influencing illness management.
High complexity
Intrusiveness lifestyle
Significant costs
Discomfort/pain
Activities are multifactorial
Ongoing consistency/daily activity
Treatment regimens can change over course of treatment
= distress, loss of convenience/freedom/flexibility
= frustration –> regimen related demands different from non-medical social understanding
= patients have to educate others
List individual factors influencing illness management.
Patient's health literacy Cultural illness beliefs Perceived social support Patient identity & perceptions Individual coping styles Coping = lifelong process Lower quality of life "Diabetes burnout" Coping/emotional distress in family members
Describe the psychological impact of type 1 diabetes.
Medication routine interferes with ability to live normal life
Freedom to eat as I wish is affected
Increased risk of depression
Elevated “diabetes distress”
Children: initially psychological resilience –> 37% at least one diagnosis of mental health problem
Adolescence: greater diabetes distress –> more depressive symptoms –> higher BG level
Explain the psychological impact of type 2 diabetes.
Short-term psychological impact limited
Longer term: risk of depression & diabetes-specific distress (comorbid conditions, diabetes complications)
Depression -> less optimal selfcare behaviours, suboptimal glycaemic control, higher mortality rates
What is the neuropsychological impact of diabetes on children?
Decreased visuospatial and psychomotor, decreased attentional skills
Discuss the neuropsychological impact of severe hypoglycaemia.
EEG abnormalities
School absence –> decreased verbal/achievement scores
Decreased psychomotor efficiency in children
Discuss the neuropsychological impact of severe hyperglycaemia.
Decreased verbal skills, decreased visuomotor integration
Slower brainstem auditory evoked potentials, increased abnormality in MRI scans
Mild impairment of memory/learning performance
Decreased attention, decreased psychomotor efficiency, decreased spatial information processing
Intensive regimens = increased risk of hypoglycaemia = neural damage
What are the effects of type 2 diabetes in the elderly?
Similar deficits in learning/memory related to metabolic control.
List the comorbid psychopathology of diabetes and depression in type 1. (psychosocial factors)
Childhood adversity
Negative influence on personality development
List the comorbid biological risk factors of type 2 diabetes and depression.
Immune dysfunction Dysregulation of HPA axis Inflammatory processes Circadian dysregulation Changes of gut microbiome/brain-gut axis Homeostatic dysregulation
Describe the comorbid psychopathology of anxiety and diabetes.
14% GAD, 40% elevated anxiety symptoms
25% PTSD symptoms
PTSD symptoms in parents of children with newly diagnosed T1DM: 24% of mothers, 22% of fathers
Describe the comorbid psychopathology of dysregulated eating and diabetes.
T1DM: 16% eating disorder
Increase subclinical levels of dysregulated eating
Increased body dissatisfaction
Anorexia nervosa: no higher prevalence rates, but more impact in death rates
Bulimia nervosa: increased prevalence, 60-80% binge eating
Intentionally omitting or underdosing insulin for weight control: 30% of adolescents with DM
Describe the comorbid psychopathology of other mental disorders and diabetes.
Psychosis - atypic antipsychotic agents (clozapine, olanzapine) can induce diabetes
Substance use disorders
Somatic symptom disorders/somatoform disorders
OCD
Name some self report tools used for diabetes mellitus.
Problem Areas in Diabetes Survey PAID
Attitude to Diabetes Scale ATT39
Insulin Treatment Appraisal Scale ITAS
Hypoglycaemic Fear Survey II - Worry Scale
Describe how to bring bad news according to SPIKES
Setting up Perception Invitation Knowledge Emotions Strategy & Summary
What is the role of the patient in communication?
Adherence
Empowerment & Self-management - enable person to make autonomous, informed decisions
Shared decision making - education, agreement on therapy goals/treatment preferences
Patient-centered approach
Monitoring psychological wellbeing routinely
Name the ABCs of effective communication.
Active listening Body language Clarify information and paraphrase Develop rapport Explain clearly Feedback Give clear signals Hear the sound of silence In conclusion
What are the psychosocial aspects of diabetes management?
Education Blood glucose monitoring Sexual dysfunction Weight management Comorbid mental health problems
Describe education in diabetes management.
Diabetes knowledge Diabetes management skills Coping skills Lifestyle change Reducing barriers Maintaining quality of life Reducing diabetes related distress Accepting diabetes as part of everyday life
How do you monitor blood glucose?
Blood Glucose Awareness Training (BCAT)
- Learn to identify best internal cues of extreme levels of BG
- Learn to anticipate extreme levels of BG based on info concerning insulin, food, exercise
- Learn to take appropriate action
Describe how you treat DM-related sexual dysfunction.
Men & women affected
Men with DM respond less well to range of medical ED treatments
Predictors in men: age, BMI, DM duration, complications
Predictors in women: depression, poor partner relationships
Combine pharmalogical and psychological interventions
Explain weight management programmes.
Nutrition education, behaviour modification, very low calorie diets, exercise.
Increased weight loss = problem : decreased weight loss maintenance
Encouraging weight maintenance rather than weight loss
Increased glycaemic control
Psychological Interventions for Emotional Problems in diabetes.
Psyc
Psychological Interventions for Emotional Problems in diabetes.
Psychological and pharmalogical interventions: decreased depression & diabetes distress
Evidence-based interventions: web based CBT, mindfulness based therapy, moderate effects in short term, small effects in long term
SSRI: short term: moderate to large effects –> decreased depression and small effects of increased glycaemic control.
Collaborative care/stepped care: moderate effect –> decreased depression, increased glycaemic control
Psychological interventions to reduce fear of hypoglycaemia : education - awareness of warning signs/reduce exposure to severe hypoglycaemia
